What is stress incontinence?
Incontinence is the involuntary release of urine, and it is common among people of all genders. The majority of studies reveal that incontinence affects around 300m people worldwide. This equates to about 5% of the population i. If you happen to be experiencing any type of incontinence, it’s imperative you understand – you are not alone.
Stress incontinence happens when movement or activity puts stress on the bladder, causing urine to leak. Movements include coughing, laughing, sneezing, running or heavy lifting ii. These movements can increase the pressure in your bladder until it becomes greater than the strength of your urethra to stay closed, resulting in leaking.
The amount of urine leaked can vary, with more passing when your bladder is very full. It’s also important to remember you won’t leak every time you sneeze. Everyone’s experience is unique but there are a number of things you can do to help and empower yourself.
What causes stress incontinence?
Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter iii.
Problems with these muscles could be caused by a number of reasons:
• Damage during childbirth – Particularly if your baby was born vaginally.
• Increased pressure on your tummy – This can occur if you are pregnant or obese and put added stress on the muscles used to prevent urination.
• Damage to the bladder or nearby area during surgery – Harm to these areas could occur during procedures such as a hysterectomy (removal of the womb) or removal of the prostate gland.
• Enlarged prostate – Especially so in older men, incontinence often stems from enlargement of the prostate gland, a condition medically known as benign prostatic hyperplasia.
• Neurological disorders – Multiple sclerosis, Parkinson’s disease, a brain tumour, a stroke or a spinal injury can all interfere with nerve signals involved in bladder control. This can impact the necessary muscles and in turn cause an increased likelihood of stress incontinence iii.
How do I treat or manage stress incontinence?
There are many different options for helping to treat stress incontinence, but the first thing to do is discuss your symptoms and your experience with a healthcare professional. This way you can both begin to map out a treatment plan that fits your needs the best. Not every treatment option works for everyone so it’s important to find what suits you.
General lifestyle changes, such as losing weight, stopping smoking and eating health, can help to reduce symptoms, however, there are also specific methods which can have long lasting benefits.
• Pelvic floor exercises – A healthy pelvic floor is a flexible pelvic floor that can contract when it needs to (e.g., to control urine) and relax when it needs to (e.g., during sexual intercourse). To support this, it helps for you to gain awareness of what your pelvic floor muscles feel like when they naturally relax and tense, this is defined as proprioception and can be understood more in a section below. This can be done through pelvic floor breathing exercises and can be aided by the use of our pelvic floor cushion, Empelvic . This is a very accessible and non-invasive way for all to help treat stress incontinence.
• Absorbent pads – Pads are a management option available if you are experiencing stress incontinence. They won’t prevent the leaking of urine; however, they can help manage any leaks when out in public. If leaks are not a major problem in your life, pads are an inclusive option.
• Pessaries - Pessaries are an effective and convenient option for women to manage the symptoms of stress incontinence, particularly for those seeking a non-surgical solution. These small, often silicone devices can be easily inserted into the vagina to help to prevent urine leakage during activities like coughing, laughing, or exercising.
Proprioception and your pelvic floor
If you’re looking for long-term treatment, training yourself in proprioception is a helpful option.
Proprioception is the ability to perceive the position and movement of the parts of your body, allowing you to interact with the environment around you without having to completely rely on visual feedback iv. It is involved in acquiring and maintaining complex motor skills, like walking, talking or learning to drive. It’s also essential in maintaining pelvic floor functions like peeing, pooping, and having pain free sex. If you happen to be experiencing stress incontinence, improving proprioception will likely be part of your treatment plan.
One of the best ways to understand proprioception is to picture yourself riding a bike. Are you staring down at your feet and consciously deciding how to move your joints and muscles in order to push the pedals? No, you don’t have to! Your brain is firing signals informing your legs to move. Your sense of proprioception is providing feedback to your brain that your legs, ankles, and feet are where they need to be, and are applying the right amount of pressure to pedals at exactly the right timeiv.
This ability doesn’t come naturally it comes through practice, and the same skills can be built with your pelvic floor. It just takes a little training.
Here are just a few ways you can boost your pelvic floor proprioception and in turn reduce the risk of leaks:
• Mindful breathing – The practice of mindful breathing can help you to reconnect to your pelvic floor and understand how your pelvic floor muscles feel, allowing you to in turn train and strengthen them. Lie flat on your back, draw attention to your pelvic floor. Inhale — feel your pelvic floor lengthen. Exhale — feel it move back up into your abdomen iv. Try repeating this for 5 or so minutes a day.
• Connect visually – It’s important to familiarise yourself with your pelvic floor and one of the best ways to do so is to take a look. Place a mirror between your legs and observe your vagina as you breathe.
• Inhale deeply. Exhale fully. Do you see any movement in your perineal area (between your vaginal opening and anus)? Do the movements connect with your breathing? This visual feedback is helpful in connecting your brain to your pelvic floor.
Stress incontinence is often complex and can take time to resolve, but you can absolutely do this. You’re not alone in your journey and there are many options that can help you find the treatment path that works best for you.
[i] Hall, S. (2019). What Percentage of the Population are Affected by Incontinence? [online] Incontinence UK. Available at: https://www.incontinence.co.uk/what-percentage-of-the-population-are-affected-by-incontinence.
[ii] Mayo Clinic (2017). Stress incontinence - Symptoms and causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727.
[iii] NHS Choices (2019). Causes - Urinary incontinence. [online] Nhs. Available at: https://www.nhs.uk/conditions/urinary-incontinence/causes/.
[iv] Swink, C. (2022). Proprioception & Your Pelvic Floor | Origin. [online] Available at: https://www.theoriginway.com/blog/proprioception-your-pelvic-floor [Accessed 19 Jun. 2024].
